An integrated theory of planned behaviour model to understand cancer screening attendance

Background: Cancer is a major public health concern worldwide and the second leading cause of death in many countries. Population-based screening programs have proven to reduce cancer mortality, as they permit early detection and early treatment. Nevertheless, screening attendance is still unsatisfactory in many populations, including Italian. According to the Theory of Planned Behaviour (TPB), screening attendance behaviour is determined by intention, which is, in turn, determined by attitude, subjective norms and perceived behavioural control (PBC). TPB has also been extended with many variables. In particular, the Action control framework bridges the intention-behaviour gap by including two Selfregulation variables – action planning and coping planning – and allows the detection of four different profiles. This study aims to (i) test a TPB model integrated with action planning, coping planning, descriptive norms, anticipated regret, cancer knowledge and (ii) understand which considered variables differentiate the profiles. Methods: A total of 319 Italian participants (aged 45-61) completed an online self-reported questionnaire assessing variables of interest and were categorized as unsuccessful non-intenders (13.3%), successful non-intenders (0.9%), unsuccessful intenders (67.6%), successful intenders (18.2%). Findings: SEM analysis confirmed the hypothesized model, and all variables were significantly correlated with the discriminant function. Successful and unsuccessful intenders showed higher levels of PBC, subjective norms and coping planning than non-intenders (ps<.01). Successful intenders reported significantly higher coping planning than unsuccessful intenders (p<.01). Discussion: These findings further extend the Action control framework and could inform about key variables for tailored interventions based on TPB extensions.